Life outcomes after paediatric kidney transplantation: a qualitative, biographical study in long-term survivors

ObjectiveThe objective of this study was to analyse the narrative life stories of children with end-stage kidney disease (ESKD) and their families to determine how health professionals can effectively support these children to achieve better life outcomes.DesignQualitative narrative biographic study.SettingWe invited every long-term survivor of paediatric kidney transplants and their families at the Medical University of Vienna between 2008 and 2013 to participate in this study.ParticipantsNineteen patients (women: n=8, 42%) and 34 family members (women: n=22, 65%) were interviewed. The patients had a mean age of 7.6 (SD +/- 5.6) years at the time of transplantation and 22.2 (SD +/- 5.4) at the time of interview.Main outcome(s) measure(s)A qualitative narrative biographical analysis was combined with computational structured topic models using the Latent Dirichlet Allocation.ResultsThe overarching finding was the desire for normality in daily life in long-term survivors and their families but with different perceptions of what normality looks like and predominance of this aspect evolving. Different strategies were used by patients (focused on their advancement) and caregivers (normality for all family members). Siblings played a major role in supporting survivors' social inclusion.ConclusionsThe strong desire for normality confirms recent findings of the Standardised Outcomes in Nephrology Group initiative, which proposes survival and life participation as core outcomes in children with chronic kidney disease. Our study should be a starting point for an international effort to identify typologies and stratified interventions for children with ESKD and their families, particularly siblings.